Small maternity units in trouble as births decline
The number of babies born in several of the country's smaller units has continued to decline this year - posing more questions over their future.
Births fell by 28pc in Portlaoise maternity unit and there was a decline of 1.6pc in newborns in Cavan Hospital in the first two months of 2016.
The end of the "baby boom" years - when Ireland's fertility rate soared - has particularly hit smaller units which have been at the centre of patient safety concerns, as more women choose to give birth in larger units instead.
Last year, some 1,606 babies were born in the Portlaoise maternity unit, a fall of 12.4pc when compared to 2014. The unit's reputation suffered after the deaths of five babies in similar circumstances over several years.
Cavan Hospital's unit, which is now the subject of two investigations following the deaths of two babies, had 1,722 births in 2015, a drop of 1.6pc.
Other smaller units also suffered a decline, including Sligo General with birth numbers of just 1,360, and Portiuncula Hospital where 1,880 babies were born.
South Tipperary Hospital maternity unit, with just 1,064 births in 2015 suffered a decline of 3.5pc.
Dr Peter Boylan, former master of the National Maternity Hospital, who is now chairman of the Institute of Obstetricians and Gynaecologists, said yesterday that part of the key to the future of smaller units is linking up with larger maternity hospitals.
He said this would include trying to attract specialists who will be willing to do shared appointments - working in larger and smaller units.
This should be more possible now that hospitals have been formed into groups, he said.
"There is also scope for training programmes for registrars working in smaller units.
"They could rotate between the smaller and the bigger units so that they get experience. That would benefit the smaller units."
However, the larger maternity hospitals are already under pressure due to lack of resources and this slows up the pace at which they will take responsibility for some of the smaller units in their group. Dr Boylan acknowledged the difficulties getting specialists to work in the smaller units.
"It is a real challenge to make the jobs attractive. That is a matter for the HSE."
Another difficulty is the number of locums - temporary stand-in doctors - who are working in smaller hospitals.
The limited number of obstetricians in several regional hospitals also means the doctors are on onerous rotas and must do on-call duty much more frequently than if they were in a larger hospital.
Krysia Lynch, of the Association for the Improvement of Maternity Services (AIMS), warned that "closing units that serve rural areas in favour of forcing women in labour to travel for several hours to a larger unit is not the solution.
"Diverting women from Cavan General to one of the Dublin units will not improve outcomes for women or babies. All Dublin maternity units are already stretched beyond their capacity.
"It will certainly lead to both more babies being born on the sides of roads and to the increased pressure on women to agree to early inductions of labour.
"High induction rates are often associated with high caesarean section rates. It is essential the Government supports the units," she added.